DAR File No. 38565
This rule was published in the June 15, 2014, issue (Vol. 2014, No. 12) of the Utah State Bulletin.
Health, Center for Health Data, Health Care Statistics
Health Data Authority Ambulatory Surgical Data Reporting Rule
Notice of Proposed Rule
(Repeal and Reenact)
DAR File No.: 38565
Filed: 06/02/2014 09:55:55 AM
Purpose of the rule or reason for the change:
This filing is in response to a review of Title R428 that identified inconsistencies in the writing of the rule.
Summary of the rule or change:
Items in the repealed rule that are not in the reenacted rule: subsections for definitions, compiling of electronic transactions, data security and integrity, exemptions, extensions, and waivers, and penalties. Items in the reenacted rule not in the old rule: none. Other changes: removes definitions of terms, exemption and extension procedures, and penalties contained in Rule R428-2. Makes technical and conforming amendments. (DAR NOTE: the proposed repeal and reenactment of Rule R428-2 is under DAR No. 38562 in this issue, June 15, 2014, of the Bulletin.)
State statutory or constitutional authorization for this rule:
- Title 26, Chapter 33a
Anticipated cost or savings to:
the state budget:
This amendment makes technical changes that improve consistency and clarity of Rule R428-11. The Utah Department of Health (UDOH) determines that these changes will not create any cost or savings impact to the state budget or UDOH's budget, since the changes will not increase workload and can be carried out with existing budget.
This filing does not create any direct cost or savings impact to local governments since they are not directly affected by the rule; nor are local governments indirectly impacted because the rule does not create a situation requiring services from local governments.
None--Small businesses will not be impacted by this rule change--as a result, the rule will have no effect on small business budgets for costs or savings.
persons other than small businesses, businesses, or local governmental entities:
Minor technical changes in Rule R428-11 will not create any cost or savings to businesses, individuals, local governments or persons that are not small businesses.
Compliance costs for affected persons:
There are no compliance costs for persons affected by these changes to Rule R428-11. Although there are several modifications within this amendment, they will not impact affected persons.
Comments by the department head on the fiscal impact the rule may have on businesses:
No effect on business because it does not materially modify current operations.
David Patton, PhD, Executive Director
The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:Health
Center for Health Data, Health Care Statistics
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231
Direct questions regarding this rule to:
- Mike Martin at the above address, by phone at 801-538-9205, by FAX at 801-538-9916, or by Internet E-mail at email@example.com
- Rex Olsen at the above address, by phone at 801-538-9498, by FAX at 801-536-0940, or by Internet E-mail at firstname.lastname@example.org
- Norman Thurston at the above address, by phone at 801-538-7052, by FAX at 801-237-0787, or by Internet E-mail at email@example.com
Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:
This rule may become effective on:
David Patton, Executive Director
R428. Health, Center for Health Data, Health Care Statistics.
R428-11. Health Data Authority Ambulatory Surgical Data Reporting Rule.
R428-11-1. Legal Authority.
This rule is promulgated under authority granted by Title
26, Chapter 33a, and in accordance with the Health Data
This rule establishes the reporting standards for
ambulatory surgery data by licensed hospitals and ambulatory
surgical facilities. The data are needed to develop and maintain
a statewide ambulatory surgical data base.
These definitions apply to rule R428-11.
(1) "Office" as defined in
(2) "Ambulatory surgery data" means the
consolidation of complete billing, medical, and personal
information describing a patient, the services received, and
charges billed for a surgical or diagnostic procedure treatment
in an outpatient setting into a data record.
(3) "Hospital" means a facility that is
licensed under R432-100.
(4) "Ambulatory surgical facility" means a
facility that is licensed under R26-21-2.
(5) "Patient Social Security number" is the
social security number of the patient receiving health
(6) "Record linkage number" is an irreversible,
unique, encrypted number that will replace patient social
security number. The Office assigns the number to serve as a
control number for data analysis.
(7) "Electronic media" means a magnetic tape or
(8) "Electronic transaction" means to submit
data directly via electronic connection from a hospital or
ambulatory surgery facility to the Office according to Electronic
Data Interchange standards established by the American National
Standards Institute's Accredited Standards Committee, known
as the Health Care Transaction Set (837) ASC X 12N.
(9) "Committee" means the Utah Health Data
Committee created by Title 26, Chapter 33a.
R428-11-4. Reporting Source of Ambulatory Surgical Data.
The reporting sources for ambulatory surgery data are
Utah licensed general acute care hospitals and ambulatory
(1) A general acute care hospital shall report discharge
data records for each surgical outpatient discharged from its
(2) An ambulatory surgical facility shall report surgical
and diagnostic procedure data records for each patient discharged
from its facility.
(3) A hospital or ambulatory surgical facility may
designate an intermediary or may submit ambulatory surgery data
directly to the Office.
(4) Each hospital and ambulatory surgical facility is
responsible for compliance with the rule. Use of a designated
intermediary does not relieve the hospital or ambulatory surgical
facility of its reporting responsibility.
(5) Each hospital and ambulatory surgical facility shall
designate a department and a person within the department who is
responsible for submitting the discharge data records. This
person shall also be responsible for communicating with the
R428-11-5. Electronic Media Data Submittal Schedule.
Each hospital and ambulatory surgical facility shall
submit to the Office a single outpatient surgical data record for
each patient discharged according to the schedule shown in Table
1, Hospital and Ambulatory Surgical Facility Data Submittal
Schedule,or a schedule mutually agreed upon by the Office and
hospital or ambulatory surgical facility.
HOSPITAL AND AMBULATORY SURGICAL FACILITY
DATA SUBMITTAL SCHEDULE
IF PATIENT'S DATE OF DISCHARGE DATA RECORD DISCHARGE IS BETWEEN: IS DUE BY: January 1 through March 31 May 15 April 1 through June 30 August 15 July 1 through September 30 November 15 October 1 through December 31 February 15
For a patient with multiple discharges, each hospital or
ambulatory surgical facility submitting electronic media shall
submit a single data record for each discharge. For a patient
with multiple billing claims each hospital or ambulatory surgical
facility shall consolidate the multiple billings into a single
data record for submission after the patient's
R428-11-6. Electronic Transaction Data Submittal. Hospitals and ambulatory surgical centers may request
data submission by electronic transaction, as submitted to the
payer through the Exemptions, Extensions, and Waivers
R428-11-7. Selection of Records to Submit via Electronic Media. Each hospital or ambulatory surgical facility licensed in
Utah shall report to the Office information relating to any
patient surgical or diagnostic procedure falling within the types
described in Table 2, as defined by the corresponding CPT codes
and ICD-9-CM codes. In case of changes in the CPT and/or ICD-9-CM
codes in future versions, the most current list shall override
the lists in Table 2.
TYPES OF SURGICAL SERVICE TO BE SUBMITTED
IF PERFORMED IN OPERATING OR PROCEDURE ROOM
DESCRIPTION CPT CODES ICD-9-CM CODES Mastectomy 19120-19220 850-8599 Musculoskeletal 20000-29909 760-8499 Respiratory 30000-32999 300-3499 Cardiovascular 33010-37799 350-3999 Lymphatic 38100-38999 400-4199 Diaphragm 39501-39599 Digestive System 40490-49999 420-5499 Urinary 50010-53899 550-5999 Male Genital 54000-55899 600-6499 Laparoscopy 56300-56399 Female Genital 56405-58999 650-7199 Endocrine/Nervous 60000-64999 010-0799 Eye 65091-68899 080-1699 Ear 69000-69979 180-2099 Heart Catheterization 93501-93660 3721-3723 Nose, Mouth, Pharynx 210-2999
R428-11-8. Data Element Reporting via Electronic Media. Table 3 displays the reportable data elements. Hospitals
and ambulatory surgical facilities shall report the required data
elements shown in Table 3, beginning December 15, 1997. The Office shall provide to each hospital and ambulatory
surgical facility an Ambulatory Surgery Data Submittal Technical
Manual which outlines the specifications, format, and types of
data to report. The Ambulatory Surgery Data Submittal Technical
Manual is effective on November 15, 1997.
REQUIRED AMBULATORY SURGERY AND MAJOR PROCEDURE
DATA ELEMENTS FOR ELECTRONIC MEDIA REPORTING
CATEGORY: NAME: Provider 1 Medical care provider identifier Patient 2 Patient control number 3 Patient's medical chart number 4 Patient's Social Security Number 5 Patient's postal zip code for address 6 Patient's date of birth 7 Patient's gender Service 8 Admission date 9 Source of admission 10 Patient's status 11 Discharge date Diagnosis and Treatment 12 Diagnosis codes 13 Procedure codes 14 Date of principal procedure 15 Modifiers for procedure codes 16 ICD9 Procedure Codes 17 Related Diagnosis Codes Charge 18 Statement covers period 19 Total facility charge 20 Primary, secondary, and third sources of payment Physician 21 Performing physician ID 22 Additional physicians' IDs 23 Type of bill (for hospital, if applicable)
R428-11-9. Compiling of Electronic Transactions. The Office shall retain records and data elements that
meet specifications listed in Tables 2 and 3 and discard all
other records and data elements received via electronic
R428-11-10. Data Security and Integrity. The Office shall adopt an encryption method to mask
patient identity and replace patient social security number with
a record linkage number as the control number. The Office may not
retain the original record containing patient social security
number and shall destroy the original record containing patient
social security number after the Department assures the validity
of the patient record. The Department of Health may conduct
on-site audits to verify the accuracy of limited data fields
within 18 months of submittal.
R428-11-11. Exemptions, Extensions, and Waivers. (1) Hospitals and ambulatory surgical facilities may
submit requests for exemptions or waivers to the Committee at
least 60 calendar days prior to the due date as listed in the
data submittal schedule in R428-11-5, Table 1. Exemptions or
waivers to the requirements of this rule may be granted for a
maximum of one calendar year. A hospital or ambulatory surgical
facility wishing an exemption or waiver for more than one year
must submit a request annually.
(2) Requests for extensions must be submitted to the
Office at least ten working days prior to the due date as listed
in the data submittal schedule. Extensions to the submittal
schedule may be granted for a maximum of 30 calendar days. The
hospital or ambulatory surgical facility must separately request
each additional 30 calendar day extension.
(3) The Committee may grant exemptions or waivers when
the hospital or ambulatory surgical facility demonstrates that
compliance imposes an unreasonable cost to the hospital. The
Office may grant extensions when the hospital or ambulatory
surgical facility documents that technical or unforeseen
difficulties prevent compliance. A petitioner requesting an
exemption, extension, or waiver shall make the request in
writing. A request for exemption, extension, or waiver must
contain the following information:
(a) the petitioner's name, mailing address, telephone
number, and contact person;
(b) the date the exemption, extension, or waiver is to
start and end;
(c) a description of the relief sought, including
reference to the specific sections of the rule;
(d) a statement of facts, reasons, or legal authority in
support of the request; and
(e) a proposed alternative to the requirement.
(4) A form for exemption, extension, or waiver can be
found in the technical manuals available from the Office.
Exemptions, extensions, or waivers may be granted for the
(a) Hospital or ambulatory surgical facility exemption:
All hospitals and ambulatory surgical facilities are subject to
the reporting requirements. Reasons justifying an exemption might
be such as a circumstance where the hospital makes no effort to
charge any patient for service.
(b) Discharge data consolidation exemption: This
exemption allows variation in the data consolidation requirement,
such as allowing the hospital to submit multiple records
containing the reportable data elements rather than a single
consolidated discharge data record.
(c) Reportable data element exemption: Each request for a
data element exemption must be made separately.
(d) Submission media exemption: This exemption allows
variation in the submission media, such as a paper copy of the
uniform billing form.
(e) Submittal schedule extension: The request must
specifically document the technical or unforeseen difficulties
that prevent compliance.
(f) Submission format waiver: This waiver allows
variation in the submission format. Each request must state an
alternative transfer electronic media, its format, and the record
layout for the discharge data records. Granting of this waiver is
dependent on the Office's ability to process the submittal
media and format with available computer resources.
R428-11-12. Penalties. Pursuant to Section 26-23-6, any person that violates any
provision of this rule may be assessed an administrative civil
money penalty not to exceed $3,000 upon an administrative finding
of a first violation and up to $5,000 for a subsequent similar
violation within two years. A person may also be subject to
penalties imposed by a civil or criminal court, which may not
exceed $5,000 or a class B misdemeanor for the first violation and
a class A misdemeanor for any subsequent similar violation within
KEY: health, hospital policy, health planning
Date of Enactment or Last Substantive Amendment: [
February 27, 2004]
Notice of Continuation: November 14, 2012
Authorizing, and Implemented or Interpreted Law: 26-33a-104; 26-33a-108
More information about a Notice of Proposed Rule is available online.
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For questions regarding the content or application of this rule, please contact Mike Martin at the above address, by phone at 801-538-9205, by FAX at 801-538-9916, or by Internet E-mail at firstname.lastname@example.org; Rex Olsen at the above address, by phone at 801-538-9498, by FAX at 801-536-0940, or by Internet E-mail at email@example.com; Norman Thurston at the above address, by phone at 801-538-7052, by FAX at 801-237-0787, or by Internet E-mail at firstname.lastname@example.org. For questions about the rulemaking process, please contact the Division of Administrative Rules.